1999 Annual Data Report (ADR) of the USRDS

This 1999 Annual Data Report US Renal Data System (USRDS) updates last year's analysis of 1) the economic cost of End- Stage Renal Disease (ESRD), 2) Medicare spending for different treatment modalities, and 3) Medicare spending by physician speciality and supplier type (e.g., medical supply company, ambulance, laboratory). Data are reported through the end of 1997. In addition to updating previously reported information, data on the interstate variation of Medicare spending are reported for the first time. The results are reported in four sections of Chapter X, entitled, "The Economic Cost of ESRD and Medicare Spending for Alternative Modalities of Treatment." Previous annual data reports were issued from 1994-1998 and can be downloaded from the USRDS web site: http://www.usrds.org.

AGENCY SPONSOR: Health Care Financing Administration

FEDERAL CONTACT: Greer, Joel
410-786-6695

PIC ID: 7198.1

PERFORMER: National Institute of Diabetes and Digestive and Kidney Diseases
Bethesda, MD

Evaluation Plan for the Medicare-DoD Subvention Demonstration

This evaluation plan describes the Medicare-DoD Subvention demonstration mandated by Section 4015 of the Balanced Budget Act of 1997. It examines issues involved in implementing the programs encompassed and presents RAND's planned approach to perform the evaluation. The plan describes how HCFA will assess the impact of the demonstration on government costs and effects on enrollees, other Medicare or DoD beneficiaries, military treatment facilities, TRICARE Lead Agents and contractors, and other stakeholders. The planned evaluation will generate operational information and "lessons learned" from sites' implementation experiences. It will conduct site visits, focus groups and interviews, analyze eligible population and enrollment data, review payment and cost data and results of several DoD Surveys of retirees and of military treatment facility patients.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Greenwald, Leslie M., Ph.D.
410-786-6502

PIC ID: 7171.1

PERFORMER: Rand Corporation
Santa Monica, CA

Interim Report: Evaluation of the Medicare-DoD Subvention Demonstration

This report presents early results from RAND's evaluation of the Medicare-DoD subvention demonstration, established by the Balanced Budget Act of 1997 to implement cost-effective alternatives for care for those eligible for both Medicare and military retiree health benefits while ensuring that total federal costs for either the Health Care Financing Administration (HCFA) or the Department of Defense (DoD) are not increased. This phase of the demonstration began to examine implications for establishing Senior Prime as a permanent part of the TRICARE program. (See also PIC ID numbers 7171 and 7171.1) TRICARE Senior Prime established Medicare+Choice health plans operated by DoD, under contract with HCFA in six demonstration sites. Senior Prime enrollees chose a military primary care manager at a participating military treatment facility (MTF) to receive their primary care and other services there. For any services not provided by the MTF, enrollees were referred to other MTFs or to civilian providers under contract to the Senior Prime network, depending on facility proximity and enrollee choice. Because this demonstration had only been underway for 6 to 10 months, depending on the site, it was too early to assess the effects of Senior Prime on dual-eligible beneficiaries or on government costs. This study includes preliminary assessments of the following activities involved in the initial phase of Senior Prime implementation: obtaining Medicare certification for the plans, marketing and enrolling beneficiaries, enrollee intake and initial service delivery, and managing and monitoring plan performance.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Greenwald, Leslie
410-786-6502

PIC ID: 7171.2

PERFORMER: Rand Corporation
Santa Monica, CA

Minimal-Burden Risk Adjusters for the Medicare Risk Program

Studies have shown that payments to risk plans under the Medicare program exceed the cost that HCFA would have incurred under traditional fee-for-service (FFS) Medicare. The overpayment occurs because the mechanism for setting the capitation rates that risk plans are paid for providing coverage of Medicare services fails to reflect health status adequately. HCFA funded this study, among others, to develop more effective risk adjusters for the general Medicare population. This project developed a risk adjuster that is based on 1) a history of serious disease (including cancer, heart disease or stroke) and severity of illness; 2) the length of time since the last hospital stay; and (3) comorbidities. The predictive power from using history of serious illness was compared to the predictive power of two existing risk adjusters--the diagnostic-cost group and ambulatory-care group models. Both predictive accuracy and operational features were compared.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Levy, Jesse
410-786-6600

PIC ID: 7190

PERFORMER: Virginia Commonwealth University
Richmond, VA

The Kansas City Evaluation of "Medicare and You (1999)" and "Medicare CAHPS": Results from Focus Groups with Aged, Disabled, and Dual Eligible Beneficiaries

The purpose of this study is to evaluate new Medicare consumer information materials, i.e., the "Medicare and You" handbook (1999) and the "Medicare CAHPS" report. This describes the main findings from seven focus groups conducted with aged, disabled, and beneficiaries dually eligible for Medicare and Medicaid (56 participants) in Kansas City, Kansas and in Missouri. The goal of the focus groups was to learn what Medicare beneficiaries though about the handbook (1999) and the report, and whether the information helped them to decide about a health plan. Beneficiaries generally believe that the handbook is: (1) comprehensive and understandable, (2) more useful as a reference tool than as a decision tool, and (3) more trustworthy than information from managed care plans. Beneficiaries also responded favorably to the CAHPS report. They believed that the CAHPS report is relevant primarily for people considering membership in an HMO. The level of trust in the report was mixed, e.g., some believed the report was intended to encourage people to join an HMO or that it was marketing material from a particular HMO. In summary, the focus group findings reflect well on both the "Medicare and You" handbook and the "Medicare CAHPS" report. Most beneficiaries understood the main messages of each booklet.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Terrell, Sherry
410-786-6601

PIC ID: 7168

PERFORMER: Research Triangle Park
Research Triangle Park, NC